Endoflip Assessment in Patients with Gastric Bypass with Fundectomy and Gastric Remnant Exploration: a Pilot Study

Roux-en-Y Gastric Bypass (RYGB) is one of the most performed Metabolic Bariatric Surgeries worldwide. Its main limitation is the difficult access to the biliary duct and the excluded stomach after surgery. To overcome this limitation, Functional Gastric Bypass (LRYGBfse), a surgical variant with an endoscopically accessible gastric remnant, was developed. However, there is a lack of research on its mechanism of action.

This study aimed to investigate the presence of a different pressure gradient between the gastrojejunal anastomosis (GJA) and the pouch isolated by the banding by comparing the Distensibility Index (DI) obtained using the EndoFlip System. In addition, clinical outcomes were evaluated.

Data of ten patients who underwent LRYGBfse with a 12-month follow-up, were analyzed. Were compared data related to DI, diameter (DM) and balloon pressure (BP) of the gastro-gastric communication (GGC) and GJA. Clinical outcomes were assessed in terms of BMI reduction, %EWL, %TWL and resolution of major obesity-related diseases.

Ten patients were included in the study. The mean DI of the GJA and GGC were respectively 8.77 ± 1.64 vs. 2.67 ± 1.02 mm²/mmHg, p < 0.0001 at 30 mL, 13.07 ± 3.59 vs. 2.96 ± 1.42 mm²/mmHg, p < 0.0001 at 40 mL and 8.09 ± 1.77 vs. 1.77 ± 1.12 mm²/mmHg, p < 0.0001 at 50 mL. Differences in DM and BP were significant (p < 0.0001). Mean BMI decreased from 40.37 ± 4.55 to 27 ± 2.96 kg/m², %EWL of 74.11 ± 15.51 and %TWL of 32.77 ± 8.29.

LRYGBfse appears to be an effective and safe surgical option. The functional data confirmed the presence of a distensibility gradient that underlies the functioning of this variant.